Mr. Archer's comparison of pharmacy services to telephone service is also
unsatisfactory because it presumes that all pharmacy services are morally
equivalent to telephone service; that, for example, no moral or ethical
questions are raised by the assertion that pharmacists are obliged to
provide abortifacients and embryocides, and may eventually be required to
provide drugs for suicide, euthanasia and executions.

In a
column carried by the Canadian Health Care Network and a religion
BLOG carried by Canada's National Post, pharmacist Cristina
Alarcon celebrated Washington State's move away from the demand that
pharmacists directly provide morally controversial services, while correctly
noting that the proposed 'solution,' - mandatory referral - would continue to
be problematic for some objecting pharmacists.1

In
response, pharmacist Frank Archer framed the issue as a conflict of
professional autonomy vs. "the right of patients to obtain legal
professional services." He insisted that anyone joining a profession is
obliged to accept "the ethics of that profession" and must give up his own
moral convictions. He further argued that professions that have a monopoly
on the delivery of services are obliged to ensure that the public has
reasonable access to them. Finally, Mr. Archer suggested that a refusal to
refer a patient for a morally controversial service is an illegitimate
interference with patient's "right to obtain legal professional services."
Along the way, he made the remarkable claim that "all codes of ethics are
based on the principle that the public has a right to obtain legal
professional services."2

To paraphrase Mr. Archer, these assertions seem to be legitimate - but
only on the surface.

As constitutional lawyer Iain Benson pointed out to Mr. Archer ten years
ago, it is incorrect to frame the issue as a conflict of autonomies. It is
best described as one involving conscientious convictions of a professional
and the expectations of a patient. Thus, wrote Mr. Benson, it "cannot be
settled by reference to one person's autonomy because two people's views or
wishes (central to autonomy) are involved." Instead, he explained, the real
issue must be settled by reference to principles of justice.3

In this respect, Mr. Archer's repeated and unqualified references to a
"right" to services are unhelpful. To say that the public has a right to
legal services means only that the public is free to obtain services that
have not been forbidden by law. It does not mean that the public can compel
individuals or groups to provide them. Such 'rights' have been described as
"negative rights" in order to distinguish them from "positive rights," like
rights to freedom of expression, conscience and religion. Positive rights
are understood to impose duties upon others to accommodate their exercise,
but it is absurd to insist that the legality of a service or product imposes
duties upon others to provide it.4

Mr. Archer's confusion on this point is illustrated by his example of the
provision of telephone service. He argues that telephone companies are not
allowed to discriminate against customers because everyone has "the right to
telephone service." In fact, a company's duty not to unjustly discriminate
is not grounded in a negative right to telephone service, but in the
positive right of a customer to be treated equally, without reference to
irrelevant personal characteristics.

Note, too, that in 2004 the BC Pharmacy Association supported plans by
pharmacists who, because they were dissatisfied with proposed fee
reductions, planned to withdraw services to First Nations peoples in remote
areas.5 It would be extremely difficult to justify the position
of the BC Pharmacy Association if, as Mr. Archer claims, "all codes of
ethics are based on the principle that the public has a right to obtain
legal professional services." But this is simply not the case. Codes of
ethics are based on the principle that ethical conduct and personal
integrity are essential elements of professional practice, not on concerns
about supply and demand.

Ironically, concern about economically motivated withdrawal of pharmacy
services from remote communities was expressed, not by the Ethics Advisory
Committee of the College of Pharmacists (of which Frank Archer was then a
member) but by Cristina Alarcon. She questioned the soundness of a
professional ethic that supports withdrawal of pharmacy services in remote
areas because of unsatisfactory fee schedules, while holding that it is
unethical to refuse to facilitate morally controversial services for reasons
of conscience.6

The ethical conformity demanded by Mr. Archer might be explicable if he
were to demonstrate the superiority of the ethical judgements that he
proposes to force upon unwilling colleagues. He might begin by explaining
how professional ethics will be improved if the only candidates admitted to
professions are those who promise that they will do what they believe to be
wrong.

Quite apart from this difficulty, his attempt at an analogy between the
Catholic Church discipline on priestly celibacy and "the ethics of the
profession" fails because it compares apples and oranges. The requirement
for priestly celibacy it is not an ethical imperative. It may prevent a man
from doing something that he might want to do, but it does not require a man
to do something that he believes to be wrong. And it does not require him to
promise that he will, in future, do something that he believes to be
unethical.

Mr. Archer's comparison of pharmacy services to telephone service is also
unsatisfactory because it presumes that all pharmacy services are morally
equivalent to telephone service; that, for example, no moral or ethical
questions are raised by the assertion that pharmacists are obliged to
provide abortifacients and embryocides, and may eventually be required to
provide drugs for suicide, euthanasia and executions. Mr. Archer was a
member of the Ethics Advisory Committee that published this statement ten
years ago,7 so his explanation of the moral equivalence of lethal
injection and telephone installation should be most informative.

While we await Mr. Archer's explanation, readers who want to more
carefully consider the subject of freedom of conscience in the profession of
pharmacy can review a number of documents and articles available on the
Protection of Conscience Project website.

4. For a
discussion of positive and negative rights as they
relate to access to health care, see Fernandez-Lynch,
Holly, Conflicts of Conscience in Health Care: An
Institutional Compromise. Cambridge, Mass.: The MIT
Press, 2008, p. 39-40.